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Now we're going to talk about one of the most serious injuries that can happen and that's called a concussion. It happens when the brain inside the skull moves because of an abrupt stop or a striking of the head and the brain literally slaps the inside of the skull. Coup is one direction. contrecoup is the other. In serious head injuries that abrupt stop can basically shut the brain down so fast that the patient falls unconscious. That is an automatic 911 call, even if they begin to recover afterwards. It's still a 911 call because that type of traumatic injury is bad enough that it could develop into a life threatening issue. But in this scenario let's say that he did not get knocked unconscious. Let's just say that this player might be feeling other signs and symptoms that could indicate they have a mild to a severe concussion. So one of the first things that they might indicate is that their head hurts. That's pretty common. They just hit it. But one of the other things we want to check for, can you look at me, can you look right at my nose, is can they follow your finger? Are they able to track with their eyes? Try to hold your head still and just watch with your eyes. There you go. That's good. Can you see me clearly? Is it nice and clear? So blurred vision, that's an indicator that there might be some swelling in there so we want to watch for that. We're also going to check for dizziness, loss of balance. He's kind of listing off to one side or the other or when I looked into his eyes I could see that his eyes, he looked like he just came off from like a merry-go-round where his eyes are kind of trying to track with me but they're going around and around. That's an indicator that they may be dizzy and not being able to keep their balance as well. I'm then going to move on down and look for signs of nausea or vomiting. They might also have a loss of memory where they're just not sure what they were doing, where am I, do you know you were playing soccer? Soccer? Why am I at the soccer field? So they might have this acute loss of memory which is another indicator of a pretty serious concussion. If any of these signs and symptoms are present - dazed, confused, all of these put together, we are going to call 911 and get the ambulance on the way. This is a situation where though it might be a mild to moderate concussion with no life threatening issues we don't want to take any chances. If we're going to make an error, err on the side of the patient. Get them into the ER and make sure we get them checked out. This is a child that's going to need to be monitored for the next 24 hours to make sure we don't have any progressive issues as the swelling might increase and the symptoms become worse. The goal is that the symptoms are already present and they're going to get less and less. That's the idea. Now make no mistake, and this is a big issue right now nowadays, if this child has any one or more concussion symptoms they are not to go back to work or play until they get a clean bill of health from the healthcare professional that states that they've been symptom free for x amount of time and now they can go back to play.
This lesson is for those times when a head injury may have led to one of the more common and serious injuries – concussions.
Pro Tip #1: Concussions occur as the brain moves abruptly from side to side inside the skull, essentially bouncing off the walls that protect it. In serious concussion cases, the brain can shut down immediately, causing the victim to lose consciousness.
Even in situations that don't involve a loss of consciousness, a person who exhibits other concussion signs and symptoms are at least mildly concussed. Part of your job is to determine if the victim is concussed and how severe it is by reading the signs and asking open-ended questions.
Warning: The most important thing to keep in mind as you deal with someone who has sustained a head injury, as soon as it appears to be a concussion, that deserves an immediate 911 call. Even if the patient begins to recover, concussions are too traumatic and can develop into something more life-threatening.
How to Assess and Treat a Concussion
As always, the first thing you want to do is make sure the scene is safe and that your gloves are on. Make sure you have your rescue mask with a one-way valve handy and begin calling out to the victim.
Are you OK? Can you hear me?
If the patient is conscious and responsive, ask yourself if there are other medical emergencies that would warrant calling 911 and activating EMS? If not, continue with your assessment.
Introduce yourself to the victim: "Hi, my name's _____. I'm a paramedic. I'm going to ask you some questions."
"Do you remember what just happened?"
"Do you know if you hit your head?"
If you suspect a head injury, ask questions about headaches, blurred vision, nausea, while also looking over the victim for concussion symptoms including:
- Eye-tracking – can they follow your finger
- Blurred vision, which indicates swelling in the brain
- Dizziness, loss of balance
- Nausea, vomiting
- Loss of memory
- Dazed and confused
If the victim exhibits any of these symptoms, it's best to call 911 immediately. If they don't, continue assessing them.
"Do you know what day it is?"
"Do you know what year it is?"
If the victim answers those two questions incorrectly, you're likely dealing with someone who has hit their head and may have a concussion. Which as you know by now, deserves a 911 call.
Pro Tip #2: When it comes to head injuries, it's better to be safe than sorry. Get the patient to the ER whenever in any doubt and get them properly examined. Always err on the side of patient welfare.
Continue to assess for signs of something more serious. How are the pupils? Is the patient breathing normally? Is the patient still responsive and seemingly alert? And continue to monitor the patient for signs of shock.
Remember, if you begin seeing signs of shock, cover the patient with a blanket or coat and try to keep them as warm as possible. Any signs of shock demand an immediate 911 call.
In concussion cases, the patient will likely require a 24-hour observation period to make sure that symptoms and swelling in the brain are reduced, which is the norm. However, these issues and symptoms can also worsen.
A Word About Injuries to the Head
The problem is that the head lacks the padding often present in other areas of the body. Which means it can easily be injured. And that injury can easily be considered serious.
There are two main types of head injuries – open and closed. An open head injury is one that breaks or penetrates the skull. Excessive bleeding can occur and controlling that bleeding will be vital for a positive outcome.
The other type is a closed head injury. Closed head injuries occur when the brain strikes against the inside of the skull and when the skull remains intact. These injuries are much more difficult to detect as there is a decided lack of visible clues.
The four subtypes of head injuries are:
- Concussion
- Skull fractures
- Penetrating wounds
- Scalp injuries
Let's take a deeper look into the physical, emotional, and behavioral signs and symptoms of a concussion.
Physical symptoms include:
- Headache
- Blurry vision
- Nausea or vomiting
- Dizziness
- Sensitivity to noise or light
- Balance problems
- Feeling sluggish
Emotional symptoms include:
- Irritability
- Sadness
- Heightened emotions
- Nervousness or anxiety
Behavioral symptoms include:
- Sleeping more or less than usual
- Difficulty falling asleep
- Changes in playing habits for kids
- Changes in eating habits
Thinking and remembering skills may also be impacted and include the following symptoms:
- Difficulty thinking clearly
- Difficulty remembering events that occurred just prior to the incident and just after the incident
- Difficulty remembering new information
- Difficulty concentrating
- Feeling mentally foggy
- Difficulty processing information